The treatment of burns, and especially of major burns, leaves much to be desired. It is difficult to avoid the formation of keloid tissue with consequent contractures and detrimental effect on muscle movement recovery. Combating infection is also difficult, particularly when the site of infection is shielded for example by burn eschar.
In the treatment of burns it is usual to combat infection by use of compositions comprising one or more active ingredient in an inert pharmaceutical carrier.
The active ingredient is typically an antibiotic such as neomycin sulphate or micronized silver sulphadiazine; an anti-bacterial agent such as cetrimide chlorhexidine gluconate or dibromopropamide isethionate, and for minor burns a local anaesthetic such as lignocaine or a mixture of such ingredients.
The inert carrier or vehicle is commonly selected having regard to the solubility of the active constituent to be carried and for those mentioned above is usually a paraffin base ointment or an oil-in-water emulsion cream. For minor injuries, lanolin and petrolatum bases have been used. Aqueous gels, such as those formed with hydroxy methyl cellulose or polyacrylic acid have not hitherto found favour for treatment of injuries where there is skin lesion or for burns.
In pharmaceutical compositions of the type discussed each of the active ingredients performs its expected function. In addition to acting as a vehicle for the active ingredient, the inert carrier in many such preparations acts as a barrier to moisture transpiration.
As a general rule neither the active ingredient nor the vehicle plays any therapeutic part in skin regrowth. Possible exceptions are the use in such compositions of paraffin which has been said to promote the rapid formation of granulation tissue and the inclusion in some compositions of allantoin which has been said to aid tissue regeneration.
Many of the compositions hitherto used cause stains to dressings or linen (e.g. Furacin stains yellow, silver sulfadiazine stains black) and some cause pain on application (e.g. sulfamylon and to a lesser degree silver sulphadiazine) and/or have a degree of toxic reaction.